2021 MEMBER GUIDE What's New Important Health Plan Information - Tufts Health Plan
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2021 MEMBER GUIDE • What’s New • Important Health Plan Information • Wellness Perks & Discounts • And More...
Dear Member, At Tufts Health Plan, we are committed to providing access to high-quality health care coverage and services to help you and your family stay healthy. Our health plans offer preventive care, prescription drug coverage, behavioral health services, care management, wellness programs, and many other great perks. We encourage you to use this member guide to: • Learn more about the latest benefit updates and digital tools • Register for your secure member account and download our free mobile app • Explore wellness programs like discounts at health facilities and more You can also visit tuftshealthplan.com for other information and resources specific to your plan. Sincerely, Tufts Health Plan
TABLE OF CONTENTS
What’s New for 2021 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Maximize Your Health Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Digital Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Pharmacy Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Wellness Discounts and Perks . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Key Terms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
FAQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
REV 110620
WHAT’S NEW
FOR 2021
Below is a summary of benefit changes and digital tool enhancements available to commercial mem-
bers. All medical benefit changes will be available beginning on January 1, 2021. All other digital tool
enhancements are available today.
MEDICAL BENEFIT CHANGES 1
Insulin Pumps – cost share varies by Medical Injectables – cost share varies
plan design by plan design
Low Protein Foods – covered in full Oral Chemotherapy – covered in full
DIGITAL TOOL ENHANCEMENTS
Intuitive Provider Search
New features include expanded search capabilities such as specialty and language, and a user
friendly home page.
NEW! Pharmacy Savings Tool
MyPrescription Shopper 2 analyzes a member’s prescriptions to search for cost savings, including
dosage or medication changes, as well as refill options. Enrolled members are alerted to these
savings through text or email.
Secure Member Account Access – Mobile
Mobile app enhancements include direct access to our wellness portal and Telehealth virtual health
care services (provided by Teladoc©). Members can also access tax forms and update or select a
primary care provider (PCP), directly within the app.
Virtual Health Care – Telehealth virtual health care services (provided by Teladoc©) are covered in
full for all plans – available 24/7. Psychiatrists can now order lab tests for quicker diagnosis.
1 Back to TopMAXIMIZE YOUR
HEALTH PLAN
3 EASY STEPS
1. ACCESS YOUR SECURE ONLINE ACCOUNT
Visit mytuftshealthplan.com or download our mobile app from the App Store or
Google Play to quickly and securely access your health plan benefits information.
• View your coverage and costs
• Select or change your Primary Care Provider (PCP)
• Review your claims, referrals, and authorizations
• Compare costs of services and doctors
2. FIND A DOCTOR OR HOSPITAL
Visit tuftshealthplan.com/find-a-doctor to find a convenient location near you.
• Search for doctors or hospitals by name or location
• Find doctors accepting new patients
• View doctors by specialty including vision, behavioral health, and more
3. SAVE TIME & MONEY
$ • Telehealth Virtual Health Care Services 4 (provided by Teladoc©) are available to
members at no cost. You can connect with a U.S.-based, board-certified doctor
anytime for everyday care, behavioral health support and dermatology services.
Set up your account at tuftshealthplan.com/teladoc
• Wellness Perks & Discounts: Take advantage of member discounts on vision,
fitness, weight management, virtual yoga classes, meditation programs, and more.
Visit tuftshealthplan.com/discounts-perks
• You can even earn rewards for choosing high-quality, cost effective providers
and facilities when you sign up for the MyRewards program.3
Visit tuftshealthplan.com/MyRewards
2 Back to TopDIGITAL TOOLS
FOR 24/7 CARE
MEMBER PORTAL + MOBILE APP LEARN MORE
Access ALL your health plan information Visit tuftshealthplan.com/DigitalTools
or ask your employer
TELEHEALTH VIRTUAL HEALTH CARE
PROVIDED BY TELADOC ©
Talk to doctors by web, phone or mobile app 24/7
TREATMENT COST ESTIMATOR +
PROVIDER SEARCH
Shop for health care just like you do for
anything else
MyREWARDS
Save time and earn money - up to $500 per year,
per member
MyWIRE
Get secure text messages and important information
3 Back to TopUNDERSTAND YOUR
PHARMACY BENEFITS
LOG IN OR REGISTER FOR YOUR SECURE ONLINE MEMBER ACCOUNT
Your member account provides you with personalized information to better manage your health
care coverage and make smart decisions about your health. Visit mytuftshealthplan.com to
get started.
LOOK UP YOUR PRESCRIPTIONS
We cover thousands of different medications, but if your current prescription isn’t on our list,
talk to your doctor about switching to a covered medication.
Many medications we cover have a cost-share (copayment, deductible, or coinsurance) —
the amount you’ll be responsible for paying, depending on your plan. The medications covered
under your plan are organized in up to four tiers:
• Tier 1 includes most generic medications and is the lowest cost to you
• Tier 2 includes many generic and brand name medications
• Tier 3 includes the most expensive generic and brand name medications
• Tier 4 includes specialty medications and is the highest cost to you
(applicable on some plans)
SEE IF YOUR PRESCRIPTION HAS SPECIAL REQUIREMENTS
If there is a “PA,” “STPA,” “QL” or “SP” after any of your prescriptions, talk to your provider.
To see definitions for these requirements, please refer to the “Key Terms“ section.
PLAN AHEAD IF YOU TAKE MAINTENANCE MEDICATION
Maintenance medications are drugs taken regularly for ongoing conditions, such as high blood
pressure or diabetes. If you’re switching from another health insurance plan to Tufts Health Plan,
make sure you have enough medication on hand to cover the transition period until your new
coverage with Tufts Health Plan begins.
Check to see that your medication is not going to expire soon, has refills, and is covered by
Tufts Health Plan. If your medication is not covered, talk to your doctor about switching to an
alternate maintenance medication that is covered - you may also request an exception review
from Tufts Health Plan.
SAVE MONEY WITH MAIL SERVICE
On some plans, you may save money if you buy a 90-day supply of medication through mail
service. Mail service provides the added convenience of home delivery instead of going to a retailer.
4 Back to TopWELLNESS
DISCOUNTS AND PERKS
Tufts Health Plan wants to help you reach your wellness goals with discounts on nutrition, mind and body,
fitness, and other services related to good health.6
FEATURED PROGRAMS
Acupuncture
With a network of local acupuncturists, Tufts Health
Plan members will now have access to unlimited
acupuncture coverage with no prior authorization or
referrals required. 7 This new acupuncture benefit was
designed to help you receive the holistic care you need
and deserve.
Your visits are subject to your plan’s specialist or primary
care physician cost share. If your plan allows for out-of-
network benefits, your visit will be subject to your out-
of-network cost share if you choose to see an out-of-
network provider. You will need to pay the provider out
of pocket and submit a reimbursement form.8
To find an Acupuncturist, visit tuftshealthplan.com and
click on “Find a Doctor or Hospital” or login to your
secure member account at mytuftshealthplan.com.
Ompractice
Tufts Health Plan members 9 can access Ompractice
virtual yoga and meditation at a discounted rate. Using
two-way video via laptop or phone, Ompractice allows
members to participate in live yoga and meditation
classes with instruction and direction from a teacher,
bringing the support, personal interaction and
accountability of a studio session wherever you are.
Learn more: ompractice.com/tuftshealthplan.
5 Back to TopHEALTH & WELLNESS TOOLS WEIGHT MANAGEMENT
Register or login at mytuftshealthplan.com and DASH for Health™
click on Start Living a Healthy Lifestyle. Visit tuftshealthplan.dashforhealth.com and enter coupon
code: “thp” to eat healthier, exercise better and lose weight.
1. Take your Wellbeing Assessment (WBA)
This online program is designed to give you the support you
2. Enroll in wellness coaching
need, from recipes and meal plans to self-tracking tools.
3. Take advantage of Nurse24 SM Sign up for the DASH for Health program for $34.50 for a
4. Get support for a chronic health condition 6-month subscription (50% off the regular subscription rate).
The Dinner Daily
FITNESS AND EXERCISE Save 25% on any Dinner Daily subscription—visit
thedinnerdaily.com/thp and use code “THP25” to sign up.
Get discounts at over 14,000 health and fitness
The Dinner Daily provides members with customized meal
facilities across the U.S. through the International
plans that fit their dietary restrictions and a shopping list
Fitness Club Network. Tufts Health Plan members
that maximizes savings with local grocery store specials.
can even try before you join with a FREE one-
week trial membership at any facility you like.10 Jenny Craig ®
Learn more at preventure.com/ifcn-tufts with Lose up to 16 lbs in just 4 weeks 12 with Rapid Results™
the password “Fit4You”. by Jenny Craig. Enjoy our special offers:
Fitness Together • Free 3-month program 13 - Food not included and $120 in
Fitness Together pairs you with a personal Food Savings (purchase required) OR
trainer in a private setting and a workout plan • Save 50% off our premium programs – Food cost
tailored to you! 11 separate
• New members pay no fitness evaluation fee Get Started Today
• New members get 10% off the purchase price • Visit jennycraig.com/THP OR
of any personal training package
• Call 877-536-6970 to schedule an appointment for a
• Existing members get 10% off the purchase FREE consultation
price of personal training packages of 36
sessions or greater. To get the discount, show MIND AND BODY
your Tufts Health Plan Member ID card when
Brain Fitness
joining any participating Fitness Together
Save 17% on the price of a subscription to BrainHQ™, an
location
online cognitive training program. Stay sharp and visit
Rather Work Out at Home? brainhq.com/thp.
• Save 10-40% on a wide array of fitness products
Cambridge Health Alliance Center for Mindfulness
Rather Race to Get Your Workout? and Compassion Discount
• Save up to 15% off registrations to a variety Save 15% on Mindfulness and Self-Compassion courses,
of races which can reduce stress and improve your overall
Other Discounts Include: wellbeing. Visit chacmc.org/courses and use access code
• Save up to 25% off online workout subscriptions “THP15” when you register.
• Save 10% off home swim lessons and lifeguard Discounts on ChooseHealthy.com
services Free shipping and up to a 40% discount on wellness
products on the site, ChooseHealthy.com. For details on
• Save up to 90% off magazine subscriptions
how to get this discount, call Customer Relations or visit
choosehealthy.com/public.
6 Back to TopMassage Therapy and Acupuncture
Reconnect your body, mind, and spirit with massage therapy or acupuncture. Massage therapy: save 25% off the
provider’s usual fee, or pay $15 per 15 minutes of massage therapy, whichever is less. Acupuncture: save 25% off
the provider’s usual fee. For a list of providers near you, call ChooseHealthy customer service at 1-877-335-2746.
Meditation 101 Audio Series
The Meditation 101 Series is designed for those who are new to meditation. Meditation 101 consists of 10 short
audio lessons that provide you with everything you need to know to begin meditating. To access this free tool,
visit app.wellable.co/meditation101, and enter the access code “THP”.
Mindfulness and Stress Management
Save 15% on the cost of tuition for the 8-week Stress Reduction or Cognitive Therapy programs at the UMass
Memorial Center for Mindfulness in Worcester, MA or online. For more information, call the Center at 774-442-
4681, or visit umassmemorialhealthcare.org/umass-memorial-medical-center/services-treatments/center-for-
mindfulness/mindfulness-classes.
MORE SAVINGS You Can Save When You Use the CVS Caremark®
ExtraCare Health Program
Eyeglasses, Contacts + Corrective Vision
You receive 20% 14 off regular-priced CVS Health
Discounts
Brand, 15 health-related items valued at $1 or more. The
Save up to 35% on the price of frames, lenses and
ExtraCare card can be used at CVS Pharmacy® stores
sunglasses when you see an EyeMed network provider.
nationwide and new members can attach the discount
EyeMed Vision Care also offers a replacement contact
to their card.
lens program, and 5-15% off the cost of LASIK and
PRK laser vision correction. • How to Get Your 20% Discount: Just show your card
Learn more at tuftshealthplan.com/eyemed. at the time of purchase to receive your discount
• If you are a new member and have a CVS ExtraCare
Home Instead Senior Care®
card: Link your CVS ExtraCare card to your Tufts Health
Get a one-time $100 credit toward charges for non-
Plan Member ID number to start receiving your discount.
medical support services at participating offices. Home
Just visit tuftshealthplan.com/extracarehealth to start
Instead Senior Care enables seniors to live safely and
the activation process. Provide your Tufts Health Plan
comfortably wherever they call home. You can also
Member ID number and your ExtraCare card number
receive a free home safety inspection once you have
when prompted
contracted for services with Home Instead Senior Care.
For more information, please contact Home Instead • If you don’t already have an ExtraCare card, you’ll be
at homeinstead.com or by phone at 1-888-484-5759. able to get one on the website. You can also pick one
To get the discount, just show your Tufts Health Plan up at any CVS Pharmacy or call 1-800-SHOP-CVS
Member ID card. to request a card before you get started with the
linking process
The Original Healing Threads™
Save 20% on patient apparel, the alternative to the • If you already have a Tufts Health Plan CVS ExtraCare
standard patient wear/hospital gown. For you and your Health card: Continue to use your existing Tufts Health
plan dependents to receive the 20% member discount, Plan CVS ExtraCare Health card to get your 20%
enter “THP” in the “Enter Promotional Code” box discount 16
located in the Shopping Bag section during checkout.
LEARN MORE
tuftshealthplan.com/Discounts-Perks
800.462.0224
7 Back to TopKEY TERMS
PREMIUM
The monthly payment you and your employer pay for your health insurance plan.
COST SHARE
Your out-of-pocket costs for services included in your health plan. These may include copayments, deductibles,
and coinsurance.
COPAYMENT
A fixed dollar amount you pay for a covered pharmacy or medical service. The amount can vary by type of
health care service.
DEDUCTIBLE
The amount you would owe during a coverage period (usually one year) for covered health care services before
your plan begins to pay.
COINSURANCE
The percentage of costs you pay for certain covered services. As an example, if your plan has 20% coinsurance,
Tufts Health Plan will pay 80% of the cost, and you’ll be responsible for paying 20% of the cost.
OUT-OF-POCKET MAXIMUM
The maximum yearly amount you must pay for your share of covered medical, pharmacy, vision, and behavioral
health services. After you spend this amount, Tufts Health Plan will pay 100% of remaining costs for covered
services.
IN-NETWORK
A group of doctors, hospitals and other care providers that have contracted with your health plan to deliver care
to you. Some health plans require the use of in-network providers only.
OUT-OF-NETWORK
Health care providers who are not in the group of in-network doctors described above. Out-of-network
providers do not have contracts with your health plan and may have higher out-of-pocket costs.
8 Back to TopPA: PRIOR AUTHORIZATION
Definition: Prior authorization is the need for your provider to tell us why it is medically necessary for you
to receive a covered medication or service. We consult with your doctor(s) to provide you with better health
outcomes, cost savings and assure your safety. Contact the doctor who recommended the medication or service.
If the doctor believes the medication or service that requires PA is necessary for your treatment, they may
submit a request for coverage to Tufts Health Plan. We’ll cover the medication or service if it meets our medical
necessity coverage guidelines.
ST PA: STEP THERAPY PRIOR AUTHORIZATION
Definition: Step Therapy Prior Authorization is an automated form of prior authorization that encourages
clinically proven use of first-line therapies so that the most therapeutically appropriate and cost-effective drugs
are used first, before other drugs may be covered. Some types of step therapy include requiring the use of
generics before brand name drugs or preferred drugs before non-preferred brand name drugs. Check our step
therapy drug list to find out which step your drug is on. If you haven’t previously taken the steps we require, and
your doctor believes the drug prescribed for you is necessary, your doctor may request authorization. You can
check the list by visiting tuftshealthplan.com/member-rx. Click on the “View Formularies” button in the “Look
Up Your Medication” box, select the drug list (formulary) for your plan and click the link to “Step Therapy Prior
Authorization.”
QL: QUANTITY LIMITATION
Definition: The quantity limit for a medication that can be purchased at any one time. A common QL is a 30-day
supply, which is the maximum number of units needed for 30 days based on the prescribed daily/weekly dose.
You’re covered for up to the quantity posted in our covered drug list. If your doctor believes you need to take
more than that quantity, the doctor may submit a request for authorization.
SP: DESIGNATED SPECIALTY PHARMACY
Definition: A pharmacy management program that requires members to purchase selected medications
from specific sources. Once your membership is effective, log in to mytuftshealthplan.com and click on “My
Coverage,” then “Pharmacy.” Call the designated specialty pharmacy provider indicated, or contact our Member
Services department to help you receive your medication without interruption.
NC: NON-COVERED
Definition: Medications that are not currently covered by us. If your provider feels you require this medication,
your provider should contact us. They may submit a request for coverage to Tufts Health Plan. We will cover
the medication if it meets our coverage guidelines. If the request is approved, you will be covered for your
prescription.
NTM: NEW-TO-MARKET DRUG EVALUATION
In an effort to ensure the new-to-market prescriptions that we cover are safe, effective and affordable, we delay
coverage of many new drugs until a physician specialist reviews them. If your doctor feels you need a new
medication, they can contact us to request coverage.
9 Back to TopFREQUENTLY
ASKED QUESTIONS
IS MY DOCTOR IN YOUR NETWORK?
Chances are good that your doctor is in our network. Tufts Health Plan has more than 57,000 health care
professionals and more than 100 hospitals across Massachusetts, Rhode Island and New Hampshire within our
network, and extends into parts of Maine, Vermont, Connecticut, and New York.
Visit tuftshealthplan.com/find-a-doctor or log into your secure online account at mytuftshealthplan.com for
a complete list of providers.
WHAT IS A REFERRAL AND WHEN DO I NEED ONE?
Certain health care plans require you to get a referral from your PCP giving you permission to see a specialist
for care. If your plan requires a referral, make sure that you have the referral before you see a specialist, or you
will be responsible for costs from the appointment.
DO I NEED TO GET NEW REFERRALS WHEN CHANGING PLANS?
Any referral you had with your previous insurance plan will not carry over. If your plan requires a referral,
you’ll need to get a new referral from your PCP.
WHAT IS PRIOR AUTHORIZATION AND HOW DO I GET IT?
Prior authorization means your health plan must approve a certain medication or service before you receive it.
Your in-network doctor is responsible for obtaining a prior authorization from us on your behalf. If your plan
offers out-of-network benefits and you go to an out-of-network doctor, then you are responsible for making
sure the doctor obtains a prior authorization.
WHERE DO I SEE OR ACCESS MY PLAN BENEFIT DOCUMENTS?
All of your plan information is easily accessible through your secure online account at mytuftshealthplan.com.
HOW DO I GET ACCESS TO A DOCTOR WHEN I’M TRAVELING?
If you have an urgent or emergency medical condition, seek care immediately at the nearest medical facility.
Members have access to urgent or emergency care from any provider regardless of network at an in-network
cost share. You can also use our Telehealth (provided by Teladoc©) services for non-urgent health care
needs 24/7.
10 Back to TopWHAT IS THE DIFFERENCE BETWEEN A GENERIC AND A BRAND NAME?
Brand name medications are typically the first product to gain Food & Drug Administration (FDA) approval.
Generic versions have the same active ingredients, come in the same strength and dosage, and are also
reviewed and approved by the FDA.
You can expect a generic version to produce the same effects as the brand name medication. The FDA works
closely with all pharmaceutical companies to make sure that all brands and generics sold in the U.S. meet
appropriate standards for strength, quality, and purity.
I HAVE A PRESCRIPTION FOR A MEDICATION THAT REQUIRES PRIOR
AUTHORIZATION. WHY DO I NEED PRIOR AUTHORIZATION?
Prior authorization helps us manage the rising cost of prescription medications to make pharmacy benefits
more affordable for you. It also helps us make sure you have the most recent and successfully proven medical
science applied to your treatments.
If your doctor feels it is necessary for you to take a specific medication, they should submit a request to
Tufts Health Plan.
ARE THERE ANY MEDICATIONS THAT ARE NOT COVERED BY MY PHARMACY
BENEFIT?
Yes, there are some prescription medications that are not covered when there is medical evidence that
proves other less costly and clinically appropriate alternatives are available.
The Tufts Health Plan Pharmacy and Therapeutics Committee reviews new medications (available and covered
by Tufts Health Plan) for safety, cost-effectiveness, and appropriateness to determine if it will be added to the
list of non-covered medications.
If your doctor believes that you have a medical reason for treatment with a non-covered medication,
they may submit a request for coverage.
WHAT DOES IT MEAN IF MY PRESCRIPTION IS EXCLUDED FROM YOUR LIST?
Tufts Health Plan may exclude from coverage prescription medications once they become available
over-the-counter (OTC).
OTC drugs can be obtained without a prescription and are not eligible for coverage by the plan. The
complete list of medications excluded from coverage along with their OTC alternatives can be found at
tuftshealthplan.com/non-covered-drugs.
11 Back to TopADDITIONAL BENEFIT DETAILS
1
Insulin pumps and medical injectables are covered, however 9
Excluding Tufts Health Direct members.
the member cost share may vary depending on plan design.
Specialty clubs and studios, such as martial arts, yoga, spin
10
Low protein foods and oral chemotherapy medications are
and personal training centers may offer different “trial” offers.
covered in full (under the Pharmacy benefit) but Saver plan
Please inquire with the owner or membership department at
members must meet their deductible first. Some plans may
these centers to verify offer.
also require coinsurance. Members should consult their plan
benefit documents for exact details on required cost share. At participating facilities only. Discounts cannot be combined
11
2021 medical benefit changes are available beginning on with any other promotion offered by the fitness location or
January 1, 2021 but also depend on your health plan or trainer.
group renewal date. First 4 weeks only. Avg. weight loss in study was 11.6 lbs
12
2
MyPrescription Shopper and Telehealth (powered by Teladoc©) for those who completed the program. Valid for 3-month
are available to fully-insured groups; other groups may elect trial membership. Weekly full menu avg. $156 (before
to add these programs - additional fees may apply. All medical discount) and any shipping costs not included. Discount split
benefit changes and digital tool enhancements described over 12 consecutive weeks with full menu purchase. Valid
above are for commercial members of Tufts Health Plan only at participating centers and Jenny Craig Anywhere. New
- not including Tufts Health Direct. members only. No cash value. Not valid with any other offers
or discounts. One offer per person. Restrictions apply.
3
MyRewards is available to fully-insured members in
Massachusetts and Rhode Island. Buy-up options are available 50% off enrollment and/or membership fees for eligible
13
for self-insured employers in Massachusetts and Rhode Island. premium programs. Weekly full menu avg. $156 (before any
MyRewards is not available with tiered products or CareLink. discount) and any shipping cost are not included. No cash
If you’re not sure whether your plan includes MyRewards, ask value. Not valid with any other offer or discounts. Valid at
your employer. participating locations and Jenny Craig Anywhere. New
members only. Restrictions apply.
4
Telehealth virtual health care services powered by Teladoc
are available to Tufts Health Plan Commercial members (not
14
The 20 percent discount is restricted to items purchased for
including Tufts Health Direct) for plans issued or renewed the health care of the cardholder only and applies to regularly
in 2020. Until further notice, there will be no member cost priced CVS Health Brand health-related items valued at $1
share or copay for this service to our employer-sponsored or more. Your ExtraCare Health discount may not be used
groups, including all self-funded groups that have this benefit in Target stores, including those with a CVS Pharmacy in
and have not opted out. If you’re not sure whether your plan them. Excludes alcohol, lottery, money orders, prescriptions
includes Teladoc, ask your employer. And during the COVID-19 and copays, pseudoephedrine/ephedrine products,
emergency, you can also ask your regular health care provider postage stamps, pre-paid cards, gift cards, newspapers and
if they’re offering virtual care services. magazines, milk (where required by law or regulation), sale/
promotional merchandise, bottle deposits, bus passes, hunting
5
Up to $500 per covered member per year. MyRewards
and fishing licenses. Not valid on any imposed governmental
is available to commercial fully-insured members (not
fees, or items reimbursed by a government health plan. Check
including tiered products, CareLink and Tufts Health Direct)
with your plan administrator for more details.
in Massachusetts and Rhode Island. Telehealth (powered by
Teladoc©), is available worldwide for everyday care services All CVS Pharmacy Brand products are 100% satisfaction
15
only. Telehealth and MyWire are available to commercial guaranteed or your money back. If you’re dissatisfied for any
fully-insured members and most self-insured members reason, you can return the CVS Pharmacy Brand product
(not including Tufts Health Direct). (opened or unopened) along with your receipt or invoice
to any CVS Pharmacy store. We’ll refund the full purchase
6
This information has been provided by the vendors and
price — no questions asked! To return the item by mail, call
has not been independently confirmed by Tufts Health Plan.
Customer Care at 1-888-607-4CVS (1-888-607-4287). Other
Check with your health care provider regarding any health
pharmacies are available in our network. You are not obligated
or medical condition before beginning any new treatment,
to fill your prescriptions at CVS Pharmacy by using the
exercise, or nutrition regimen. Discounts are subject to
ExtraCare Health benefit.
change at any time.
Members with an existing Tufts Health Plan CVS ExtraCare
16
7
Acupuncture will be offered as a benefit January 1st for
Health Card should not try to use the link tuftshealthplan.
new members and upon renewal date for existing members.
com/extracarehealth. This site is only for new members. If
8
Reimbursement applies only to plans that have out-of- you need to replace your existing physical card or transfer
network benefits. For in-network only plans, members must ExtraCare rewards, call 1-888-543-5938 and select option 2.
visit a contracting provider within the Tufts Health Plan
network.
12 Back to TopDISCRIMINATION IS
AGAINST THE LAW
Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate on the basis of race,
color, national origin, age, disability, or sex. Tufts Health Plan does not exclude people or treat them differently
because of race, color, national origin, age, disability, or sex.
Tufts Health Plan:
• Provides full and equal access to covered services under the federal Americans with Disabilities Act of 1990 and
Section 504 of the federal Rehabilitation Act of 1973. This includes free aids and services to people with disabilities
to communicate effectively with us, such as:
— Written information in other formats (large print, audio, accessible electronic formats, other formats)
• Provides free language services to people whose primary language is not English, such as:
— Qualified interpreters
— Information written in other languages
If you need any of the above services, have questions regarding any provider directory information, or would like to
report an inaccuracy or network access issue, please contact Tufts Health Plan Member Services at 800.462.0224.
To report provider directory inaccuracies electronically, please visit https://tuftshealthplan.com/find-a-doctor and
select your plan. Search or select the Provider whose information you believe needs updating and click “Tell us if
something needs to change”.
Please note that if you have complaints regarding provider directory inaccuracies or provider network access issues,
you also have the right at any time to contact the Commonwealth of Massachusetts Division of Insurance at
(877) 563-4467, Option 2 or www.mass.gov/doi.
If you believe that Tufts Health Plan has failed to provide these services or discriminated in another way on the basis
of race, color, national origin, age, disability, or sex, you can file a grievance with:
Tufts Health Plan, Attention:
Civil Rights Coordinator Legal Dept.
705 Mount Auburn St, Watertown, MA 02472
Phone: 888.880.8699 ext. 48000, [TTY number — 800.439.2370 or 711]
Fax: 617.972.9048
Email: OCRCoordinator@tufts-health.com
You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Tufts Health Plan
Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services,
Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at
https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services:
200 Independence Avenue, SW
Room 509F, HHH Building, Washington, D.C. 20201
800.368.1019, 800.537.7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
tuftshealthplan.com | 800.462.0224
THP-OCR-NOTICE-10/2020
13 Back to TopFor no cost translation in English, call the number on your ID card.
Arabic . یرج االتصال عىل الرقم المدون عىل بطاقة الھویة الخاصة بكى
ى للحصول عىل خدمة ر
،التجمة المجانیة باللغة العربیة
Chinese 若需免費的中文版本，請撥打ID卡上的電話號碼。
French Pour demander une traduction gratuite en français, composez le numéro indiqué sur votre carte
d’identité.ى
German Um eine kostenlose deutsche Übersetzung zu erhalten, rufen Sie bitte die Telefonnummer auf
Ihrer Ausweiskarte an.
Greek ΓιαىδωρεάνىμετάφρασηىσταىΕλληνικά,ىκαλέστεىτονىαριθμόىπουىαναγράφεταιىστηνى
αναγνωριστικήىκάρταىσας.
Haitian Creole Pou jwenn tradiksyon gratis nan lang kreyòl ayisyen, rele nimewo ki sou kat ID ou a.
Italian Per richiedere la traduzione in italiano senza costi aggiuntivi, chiamare il numero indicato sulla
carta di identità.
Japanese 日本語の無料翻訳についてはIDカードに書いてある番号に電話してください。
Korean 한국어로 무료 통번역을 원하시면, ID 카드에 있는 번호로 연락하십시오.
Navajo
Persian. ھ برای
ھ فاریس رایگانن ترجم ى
بزنی ىد زنگ تان شناسائى کارت در مندرج تلفن شماره ب ى
Polish Aby uzyskaćىbezpłatne tłumaczenie w języku polskim, należy zadzwonićىna numer znajdujący sięى
na Pana/i dowodzie tożsamości.
Portuguese Para tradução grátis para o português, ligue para o número no seu cartão de identificação.
Russian Для получения услуг бесплатного перевода на русский язык позвоните по номеру,
указанному на идентификационной карточке.
Spanish Para servicios de traducción gratuitos en español, llame al número que aparece en su tarjeta de
miembro.
Tagalog Para sa walang bayad na pagsasalin sa Tagalog, tawagan ang numero na nasa inyong ID card.
Vietnamese Để có bản dịch tiếng Việt không phải trả phí, gọi theo số trên thẻ cănىcước của bạn.
List-Languages-THP-ID-10/2020
14 Back to TopCONTACT US
MASSACHUSETTS MEMBER SERVICES
800.462.0224 (TDD/711)
Monday–Thursday, 8 am–7 pm; Friday, 8 am–5 pm
RHODE ISLAND MEMBER SERVICES
800.682.8059 (TDD/711)
Monday–Thursday, 8 am–7 pm; Friday, 8 am–5 pm
VISIT US ONLINE
tuftshealthplan.com/Ask-Member-Services
Interpreter Services Available:
With the help of Language Line Solutions, we speak more than 250 languages.
Tufts Health Plan complies with applicable Federal civil rights laws and does not discriminate
on the basis of race, color, national origin, age, disability, or sex.
Por servicio de traducción gratuito en español, llame al número de su tarjeta de miembro.
若需免費的中文版本, 請撥打ID卡上的電話號碼。
705 Mount Auburn Street, Watertown, MA 02472 | tuftshealthplan.comYou can also read
